Concordia University--Irvine, CA
Office of the Registrar
STATEMENT OF COMPLETION
Name: _________________________________________
Student ID#: _______________________
1. This graduating senior is requesting that the Registrar process this Statement of Completion. This
student is my advisee and we have discussed what courses are appropriate to apply towards the Fifth
Year Program.
______________________________________________
School of Education/Faculty Advisor Signature
_________________________
Date
2. This graduating senior has applied for admission into the Fifth Year Program and is, therefore,
eligible to request this Statement of Completion.
______________________________________________
Director of Credential Program/Lead Credential Analyst Signature
_________________________
Date
3. My Undergraduate requirements will be fulfilled in (semester/year): _________________________
______________________________________________
Student Signature
_________________________
Date
RETURN TO THE REGISTRAR’S OFFICE FOR PROCESSING
4. Degree requirements have been met as of (semester/year):__________________________________
The following courses will be applied to the Fifth Year:
_________________________________
sem/hr:______________________
_________________________________
sem/hr:______________________
_________________________________
sem/hr:______________________
_________________________________
sem/hr:______________________
Total hours applied to Fifth Year Program:
_____________
_________________________________________________
Registrar’s Signature
F:\REG\FORMS\STMTOFCOMPLETION
__________________________
Date